# A client with obsessive-compulsive disorder becomes highly anxious while delaying a handwashing ritual according to an agreed exposure and response prevention plan. Which action should the nurse take?

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> language: en  
> subject: Mental Health Concepts  
> category: PSI

## Question

A client with obsessive-compulsive disorder becomes highly anxious while delaying a handwashing ritual according to an agreed exposure and response prevention plan. Which action should the nurse take?

## Option

1. Explain that the feared event cannot occur and leave the client to control the thoughts alone
2. Acknowledge the anxiety and coach the agreed coping skill while the ritual is delayed **✔ Correct answer**
3. Permit the handwashing ritual without limits whenever the anxiety begins to rise
4. Tell the client the ritual is irrational and insist that it stop immediately today

**Correct answer: 2**

## Explanation

Exposure and response prevention intentionally pairs a planned trigger with supported delay or prevention of the compulsion. The nurse should validate the client's distress and coach the coping strategy already established in the treatment plan without providing reassurance or abruptly abandoning the plan.

## In-depth explanation

Quick answer
Stay supportive, name the anxiety, and coach the agreed coping skill while the ritual is delayed. This follows the planned exposure and response prevention approach.

Why this is correct
Compulsions briefly reduce anxiety and therefore reinforce the obsession-compulsion cycle. Supported practice tolerating anxiety without completing the ritual allows the distress to decline without the compulsion and builds confidence in a different response.

Easy analogy or mental picture
The ritual is like a shortcut that relieves anxiety for a moment but keeps the same loop open. ERP practices staying on a safer route until anxiety falls; the analogy does not mean exposure should be improvised or forced outside an individualized plan.

Memory hook
Name the anxiety, follow the agreed exposure plan, coach coping, and do not feed the ritual.

NCLEX decision rule
When ERP is already prescribed, support the client through planned anxiety without reassurance, ridicule, or unlimited ritual completion. Do not independently intensify exposure beyond the agreed treatment plan.

Why the other choices are wrong
Logical reassurance does not stop intrusive thoughts and can become part of the cycle. Unlimited ritual completion reinforces the compulsion, while confrontation and forced abrupt stopping can increase distress and damage trust.References

- [1]NCSBN: 2026 NCLEX-RN Test PlanNational Council of State Boards of Nursing

- [2]NIMH: Obsessive-Compulsive DisorderNational Institute of Mental Health

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